Creating Waves of Awareness
Every homeopathic physician has to face a serious problem of failures in practice, of inadequacy of homeopathic medicines working in some situations - partial simillimums, too short-time action of seemingly proper remedy, relapses of symptoms in spite of apparently matching remedy.
Even skillful homeopaths experience difficulties in selecting medicines for some vague clinical conditions where evident suffering is associated with no clear pathologic findings and with absence of well-defined clinical entity. Management of these situations in homeopathy depends on the physician’s experience and school, and usually includes intercurrent remedies, specific anti-miasmatic nosodes, changing potencies or remedies, applying some concepts - kingdoms, doctrine of signatures, extra-miasms, implementation of new and poorly proved remedies, exploring psychological processes, etc.
These management efforts sometimes work and result into amelioration, but sometimes fail and therefore help sceptics of homeopathy. Judging and criticizing these methods cannot clarify the situation and solve the practical problems, cannot reduce the patients’ disease burden. However, in these management efforts we often forget treasures presented by Hahnemann - deeper understanding of miasmatic process and, more generally, disease process. We often see that miasmatic process is not covered strongly and completely, patients’ manifestations are not understood truly in miasmatic point of view, and thus prescribed homeopathic medicines provide only insufficient influence on miasmatic process and disease itself.
For better understanding of psora (and latent psora), we need to clarify a whole process of disease formation – so pathophysiological and clinical concepts of health, premorbid stages and disease require thorough consideration and matching with principles of homeopathic miasmatic methodology.
Health is a process of preservation and development of physiologic (somatic) and mental functions, an optimal functioning. It is clear that functioning depends on emotional state (and other innner factors) and outer circumstances (physical, chemical, biologic and social – behavioral, psychologic factors), social background and environment (social habits and patterns, traditions, community structure), information (including medical facts and speculations). In this context, norm is a complex of functional resources that are adequate to external influences. Norm also covers other aspects: subjectivity, social and cultural attitudes, statistical approach – these aspects determine certain understanding (perception) of disease or premorbid condition.
Premorbid conditions result from increased consumption of functional resources, with changed sensitivity and susceptibility, and manifest first only in interaction with specific environmental factors, or purely under certain conditions, or only in particular state of the body (fatigue, mental or physical exertion, menstrual period, pregnancy, etc). Premorbid conditions demonstrate a dysbalance in courses of physiologic processes, with preserved functional resources (or with slight decrease of them). At first, major role is played by nonspecific general sensations concerning whole body – altered thermoregulation, activity, sleep, appetite, but afterwards more local sensations involve specific organs or systems. We can identify criteria helping to differ these premorbid states from health (and from further diseasy condition) – frequency of those sensations (or events), duration of them and their influence on overall functional capacity.
Disease presents with evident functional disturbance, decrease in functional capacity due to certain sensations or events (general or local – attached to specific body parts, organs or systems). Analyzing the disease, we consider its cause and source (impact of outer or inner factors), but all outer factors always act by involving inner processes, launching reactions of inflammation, proliferation, releases of humoral or immune substances. That increases earlier dysbalance of physiologic processes, characteristic for premorbid state.
When we outline the whole disease (and premorbid) phenomenon, we see two elements: sensation (or event) itself, and attitude to this sensation (event) as unpleasant, harmful, disagreeable, unwanted, defective one. The attitude to the discomfort is not always proportional to intensity of this discomfort, but more frequently is a function of evaluation category (“I don’t like it”, “it was absent before”, “I don’t want it”), subjectivity (“it should not be”), interpretations, cultural and social effects (“ugly”, “noticeable by others”), statistic approach (“others don’t have”) – thus subjective criteria of “normality” are formed. Moreover, all these attitudes attract fear of unknown and unfamiliar (self-preservation instinct) as well as other emotional responses to discomfort (discontentment, fear of future, grief), persistent thoughts (theorizing) on causes, diagnosis, prognosis – after that usually there is a necessity of imaging or tests (bringing diagnoses and examinations), and other cycle of emotional and mental reactions reappears. In this respect, we have also mention an increased sensitivity to pain, as an individual trait that gives more intensity and emotional taint to those reactions. Generally speaking, disease has three components – pain (discomfort sensations or events), dysfunction and structural changes (destruction, deformation, proliferation) – and three aspects: subjective (sensations and attitude to them), objective (tests results) and social (reaction of society). Furthermore, disease can include changes in sensitivity and susceptibility – sensitivity increased (tactile, smell, hearing) or decreased (on affected part), reactivity excessive (mild stimulus causes violent signs) or lacking (no reaction to remedies), or inadequate (altered in time, intensity or location).
In “Chronic Diseases” and “Organon”, Hahnemann defined three variants of Psora - latent (progressing in occult manner after suppression of primary skin condition), active (secondary, chronically producing multiple diseases) and acute (acute diseases). One interesting thing - we can see that Hahnemann differentiated the three variants of psora by two clinical criteria: discomfort (amount of unpleasant sensations, pains and problems, uneasiness, ets) and functional capacity (ability to perform usual bodily and mental functions of human life). Acute psora - severe discomfort and dramatically reduced functional capacity, active psora - moderate to severe discomfort and evident or moderate disorders of functional capacity. Latent psora, according to Hahnemann - person appears healthy, considers oneself healthy (discomfort is slight), carries usual life activities, without any (or very little) limitations (functional capacity is nearly normal). Thus, absence of major functional disturbances assigns this inidvidual to a group of apparently healthy people. But Hahnemann mentioned many times about the signs and manifestations of “that psora gradually grows inside” - therefore, it is not only discomfort and functional capacity that can present miasmatic process.
List of latent psora manifestations in “Chronic diseases” covers several pages - that discourages everyone and gives a feeling of no logic behind it. But if we thoroughly analyze and generalize these symptoms presented by Hahnemann in “Chronic Diseases”, we understand that all of them fall into 5 groups (or categories, “roots”):
Assessing these 5 categories of latent psora manifestations from clinical and pathophysiologic point of view, we understand that they describe the core points of every disease process from preclinical stage (premorbid condition) to severe functional disorders of advanced pathologic conditions. It is amazing that other miasms (besides psora) - sycosis, syphilis, tuberculosis (pseudo-psora) - appear to have the same tendencies within. The main differences between other miasms and psora are presence of structural tissue changes and nature of those changes: hypertrophy and hyperplasia for sycosis, destruction active or passive for syphilis, unresolved pathologic changes for tuberculosis (pseudo-psora) lying between psora and syphilis.
In a book “Chronic miasms: Sycosis, Psora and Pseudo-psora”, J.H. Allen explored these 5 categories in depth, especially in connection with pseudo-psora, and grouped latent psora symptoms in different way, adding one more category - diathesis (a tendency, predisposition to specific repeated manifestations, locations, course of disease or group of diseases). According to J.H. Allen, these categories are - Dyscrasia, Idiosyncrasia, Diathesis, Cachexia and Suppression of symptoms. To understand clinical and homeopathic value of these concepts and terms, we can consider all of them in details.
“Dyscrasia” means “improper mixing of juices” in Greek. The term was designed by doctors of Knidos school, ancient Greece. Humoral theory of diseases, prevalent at that time, postulated that human body comprises opposite juices (principles, roots, origins) that mix and thus provide human body functioning. If human is healthy, the opposite juices mix properly, with none of them giving burden or causing discomfort. If some juice dominate over others, there is a condition called “improper mixing” - when dominating juice gives troubles to a body. In modern pathophysiologic understanding, this is a premorbid condition - transitional phase between health and disease, when discomfort is so mild that no regular functioning is disturbed, no (or least) usual activity is limited. During this dyscrasia state, when functions are preserved and restrictions are absent or minimal, but discomfort is present - emotions only could be disturbed, as every human body juice (according to humoral theory of disease) corresponds to specific emotion. And these disturbed emotions (because “something is wrong, however functions are not disordered”) mainly cause a search for medical advice, examinations or investigations. Modern allopathic medical system works through labelling condition as diagnosis, without paying much attention whether functions are impaired or not, and diagnosis is rigidly chained to drugs or procedures - that launches mechanism of latent psora into escalation.
During homeopathic interview, differentiation between latent psora (premorbid condition) and active psora (actual functional disorder, with other miasmatic states) as well as discomfort itself (sensations) and attitude to it (sensitivity to pain, emotional reactions, persistent thinking). Pure dyscrasia is a rare object of homeopathic intervention, but important part of whole understanding is to reveal connection between discomfort sensations and attitude to them.
Dyscrasia, premorbid condition, can be described with the rubrics that fall into three groups. First is general feeling that “everything is bad” with multiple disagreeable sensations but without significant functional disorders (such rubrics as “Sick feeling”, “Delicate sickly easily enervated”). Second group covers descriptions of uncomfortable sensations and events that are changeable in characteristics, location, modality (“Pain wandering”, “Symptoms wandering”, “Symptoms change”). Third one is emphasized on connection between discomfort symptoms and emotional disturbance that sometimes gives more troubles than physical discomfort as such (e.g., “Irritability from pain”, “Anxiety heart complaints with”, “Despair recovery”).
“Diathesis” means “inclination, tendency, disposition, propensity” in Greek. In modern medical lexicon, this term is nearly abandoned, considered out of date and limited only to childhood conditions. However, all users of the term emphasize a hereditary character of this predisposition, and clinical observations demonstrate that inclination to specific repeated manifestations, locations, course of disease or group of diseases is a basis of chronicity - so long-standing courses of allopathic medications are needed, and latent psora is augmented. During homeopathic interview, we also need to differentiate latent and acitve psora, as well as discomfort and attitude to it. Characteristics of diathesis (tendency to discomfort) include all components of complete symptom and all manifestations describing reactions to discomfort. In this, we also use rubrics describing general feeling “everything is bad” – Sick feeling, Delicate sickly easily enervated. Other group of rubrics – outlining general tendencies in development, direction and change of symptoms: Symptoms wandering, Symptoms change, Symptoms alternate, Symptoms diverse, Symptoms group recur, Symptoms radiating spreading, Symptoms relapsing, Symptoms symmetrical, Contradictory and alternating states, Symptoms go backward (downward, forward, outward, upward).
“Idiosyncrasia” means “unusual, strange mixing of juices” in Greek. In modern medicine, it is a morbid reaction to some nonspecific stimuli (unlike in allergy, where stimuli are proteins and antibodies are formed, or lymphocytes are sensibilized) or to regular environmental objects well-tolerated by everyone. Idiosyncrasia includes sensitivity and susceptibility changes - to increase as well as to decrease. Increased sensitivity and susceptibility cause more problems in clinical aspect - these are adverse or unusual reactions to medicines, to usual (protein-free) foods, excessive aversion to slight intensity of environmental factors (light, odors, sounds). Decreased sensitivity is mostly a theme of eccentric stories or anecdotes about “unfeeling thick-skinned” individuals, but decreased susceptibility can be a matter of worry in medical staffers who see patients not responding to usual dosages of strong medications. Nevertheless, strange and aberrant reactions to common factors require allopathic medications in repeated manner - that also escalates latent psora.
Idiosyncrasia, abnormal sensitivity and susceptibility, requires 4 groups of rubrics. First one, increased sensitivity (Sensitiveness drugs to, Sensitiveness internally, Sensitiveness externally, Sensitiveness pain to, Sensitive light to, Sensitive music to, Sensitive noise to, Sensitive odors to, Sensitive touch to). Second one covers decreased sensitivity (Analgesia, Painless of complaints usually painful, Anesthesia insensibility, Want of sensitiveness). Third group includes rubrics of increased susceptibility (Irritability excessive physical, Allopathic medicine oversensitive to, Remedies oversensitive to). Fourth one is for decreased susceptibility (Reaction lack of, Irritability lack of physical, Remedies fail to act when well selected).
One important notion is that changes in sensitivity and susceptibility can be not only a basic element of latent psora (premorbid condition or apparently healthy life), but also an event emerging during an acitve (or chronic) disease process. In this case, rubrics of increased or decreased, or perverted sensitivity and susceptibility should be a part of totality.
Decreased susceptibility requires some special attention – this is a very serious problem in homeopathic (and all medical) practice, when well-selected remedies apparently highly similar do not work or induce very low, slow and limited response. Causes of this low susceptibility are exhaustion (fatigue), low strength or endurance and speed, poor mobility (inertness), inhibition (standstill), tolerance (decreased reaction to repeated stimulus) and local weakness (block, pathological dominant due to some degree of structural changes). In many cases, inadequate general susceptibility results from poor reactivity of some local diseasy point – this place should be therefore identified and characterized by rubrics concerning local weakness, local sensitivity deficit as well as modalities, clinical relationships and concomitant symptoms.
J.H. Allen in his book mentioned “cachexia” as a marking term for depletion of vital force, but we can also name it as weakness, asthenia - that is basic clinical condition both preceding major clinical manifestations of acute or active psora and resulting from intense struggle of vital force along with possible damage from allopathic medicaments.
Depletion of vital force (weakness, asthenia, cachexia) is very nicely covered by rubrics:
Weakness dyscrasia from deep-seated, Weakness exertion from slight, Delicate sickly easily enervated, Vitality decreasing. However, asthenic state needs much considerations from clinical angle, and we cannot take weakness per se, but should investigate a case thoroughly to see causes of asthenia, level of it, pathologic process behind it, individual symptoms.
All tendencies of latent psora are actualized and intensified through use and abuse of allopathic drugs and procedures - surgeries, local methods including ointments and applications with strong local influence - aimed to suppress abnormal manifestations, not considering individualization of disease and patient. Hahnemann and other masters and stalwarts of homeopathy wrote so extensively about suppression of symptoms by allopathic drugs and procedures, therefore it’s needless to say how widely medicaments use and abuse have spread nowadays, with consequent increased death rate from “drug disease”, innumberable complications, strange and unusual manifestations, hereditary problems and sudden so-called unnoticed severe diseases - that is a payback of latent psora.
Obviously, intensity and consequences of suppression are different in accordance with what symptoms (manifestations) were suppressed and with the method of suppression. So, we can outline 3 groups of situations combined according to manifestations suppressed and suppression methods: suppression of local (external) symptoms (eruptions, normal discharges, pathologic discharges) by local means (or allopathic medicaments); suppression of internal symptoms by allopathic drugs (painkillers, hormones, antibiotics, inti-inflammatory drugs, antidepressants, antihypertensives, etc); suppression of external or internal symptoms by surgical procedures.
For local symptoms suppression by local or general allopathic medicaments, rubrics are quite understandable - Coryza suppressed agg, Discharges suppressed, Mucous secretions suppressed, Eruptions suppressed, Perspiration suppressed. More difficult task is to select rubrics for suppression of internal symptoms due to allopathic drugs (painkillers, hormones, antibiotics, inti-inflammatory drugs, antidepressants, antihypertensives, etc) - logically matching rubrics are “Abuse of, poisoning with medicaments”, “Abuse of, poisoning with drugs in general”, but additional search in Robin Murphy Repertory and in Complete Dynamics software gives a good list of 39 remedies:
agn, aloe, apis, arn, ars, bapt, camph, carb-ac, carb-v, cham, chin, coff, coloc, com, gels, hep, hydr, ip, kali-i, lob, lyc, mag-s, nat-m, nat-p, nit-ac, nux-v, op, paeon, ph-ac, puls, sec, sep, sil, sulph, teucr, thuj, aven, carc, buth-aust
This list is obviously incomplete and requires further clinical verification and adjustment.
One more hint on looking for and understanding drug disease (suppression of symptoms by allopathic medicaments). In old times, when repertories were being created, Cinchona (due to its major component, quinine hydrochloride) was widely used as an antipyretic, painkilling, anit-malarial and antiarrhythimc drug. Investigations revealed Cinchona’s mild antibacterial activity, influence on zymotic and decay processes, impact on blood cells (larger RBC volume, better oxygen binding by hemoglobin, lower WBC mobility) and general suppression of leucocytic reactions and pus formation. Some studies disclosed cardiovascular effects of Cinchona: higher pulse rate, increased blood pressre (medium doses), inhibition and slowing down the cardiac function (large doses). Old time doctors used quinine for convulsions (not epileptic or choreic) and neuralgias, nervous headaches. If quinine action is a sum of antipyretic, painkilling, antiarrhythmic, mild antibiotic properties, thus its toxic influence (overaction, excessive intake), but without cachexia, can be considered analogous to drug disease. Therefore, another rubric of drug disease can be:
Generalities; intoxication, after; china abuse, from, without quinine cachexia (Интоксикация от избытка хинина, без кахексии):
alst-s am-c am-m ant-t APIS apoc ARAN ARN ARS ars-i ars-s-f asaf bamb-a BAR-C BELL bry CALC CALC-AR cann-s CAPS carb-ac CARB-V cean cedr cham chelo CHIN CHIN-AR chin-s CINA coff corn-f cupr cycl dig ELAT eucal EUP-PER FERR gels helia HELL HEP HYDR ign iod IP kali-ar LACH LED maland malar mang MENY MERC morph nat-c NAT-M NIT-AC nux-m nux-v pall PH-AC phos plb PULS RHUS-T salv samb SEL SEP spig STANN sul-ac SULPH thea VERAT xan
Combining this rubric with previously mentioned 39 remedies presents a good batch of 97 medicines, that appears to be a complete list. However, new search and verification of more remedies for drug disease is welcomed.
Rubrics used for suppression of external and internal symptims by surgical procedures are general and local. General rubrics define reaction (changes of sensitivity, susceptibility, vital force depletion) of whole body to trauma – Injuries operations from, Pain operations after, Reactions lack operations after, Weakness operations after. There is a group of rubrics for general effects after specific types (localities) of surgeries – Operations after calculi for, Operations after chest of, Fistulae operations of after, Operations after deeper tissues, Operations after gallbladder of, Operations after orifices of, Tonsillectomy ailments after, Warts (condylomata) suppressed, Cautery silver nitrate antidote to, Radiation sickness or side effects. Local rubrics are connected with consequences of surgeries on various organs and systems – one can search for “operations” in corresponding repertory part (e.g., Nausea operations on abdomen after, in Stomach).
Summarizing, we can describe the whole process of latent psora (and therefore basic miasmatic process) as follows. Usually latent psora starts from dyscrasia: uncomfortable sensations and events, that are not connected with functional disturbances, not so frequent and so prolonged to be considered as a disease and to be labelled a diagnosis - such situation we frequently see in even small children with many mild worrisome manifestations that do not alter growth and development, with all functionality preserved. Other variant of latent psora course is idiosyncrasia: oversensitivity or excessive reactions to environmental (food, air, climate, etc) factors - these events are with dyscrasia, remain transitory, mild and do not impair functions, growth and development. Of course, we put aside situations with clinically severe pathologic reactions and oversensitivity - these symptoms fall into category of active psora (or pseudo-psora). Important notion is that dyscrasia and idiosyncrasia manifestations usually lead to allopathic drugs use and consequent suppression of symptoms - this magnifies total latent psora load. Repeated dyscrasia and idiosyncrasia episodes form a tendency, inclination, propensity to specific location, course and complications of morbid events - it is diathesis that rarely remains within psora, but commonly develops into sycosis (proliferation), syphilis (destruction) or pseudo-psora (chronically acute state). Weakness (depletion, cachexia) infrequently stands in the early development of latent psora - such situation demonstrates heavy inherited miasmatic load. Typically, cachexia progresses as a late event, after multiple suppressions of symptoms, when latent psora and other miasms’ load gets augmented and vital force exhausts.
Understanding the whole dynamics of latent psora development gives many possibilities to change the complete process of homeopathic methodology application: in case taking, in understanding what is to be treated in a case, in totality formation, therefore repertorial rubrics selection, further final choice of remedy, potency and repetition schedule. With a view of latent psora elements (dyscrasia, idiosyncrasia, diathesis, suppression and depletion), in case taking we aim to differentiate between active psora and latent psora, via presence and severity of functional disorders, separately from merely sensational manifestations (pure dyscrasia), to note diathesis tendencies (location, course, complications), to give special importance to symptoms suppression (when due to allopathic drugs or procedures, discomfort events disappeared in repetitive way), to assess sensitivity to environmental factors and consider excessive, odd or diminished reactions (at least to allopathic drugs). As dyscrasia (premorbid condition) can include marked emotional responses to discomfort events, in case taking we have to disclose emotional (or mental) concomitants to physical sensations. What is to be treated in a case usually points to the most marked (important, serious) functional disorder - so, if a heap of various symptoms croud, we can select as the highest rank those which alter functionality in the major way. All these important observations we include into proper case understanding and incorporate additional rubrics to basic totality.
Posology part of targetting latent psora is the most difficult item. However, from studies of the book “In Search of the Later Hahnemann” we see that in later period of work Hahnemann many times started cases with Sulphur LM4 (or LM8), and after that the situation changed either to acute manifestations (afterwards covered with acute remedies in moderate or high C-potencies) or to amelioration in many aspects except one-two significant ones (afterwards covered to appropriate chronic remedies in C-potencies). We can start by taking this Hahnemannian approach and using LM-scale from LM-4 onward. Practical results of using LM-scale in cases with significant influence of latent psora, where dyscrasia, idiosyncrasia, diathesis, suppression and depletion are very marked, but functionality of patiens is preserved, prove that LM-scale opens wide possibilities in decreasing a discomfort burden in the patients. Even in pathologic cases and in cases with active psora (or other active miasm), there are situations where targetting latent psora is a vital task - especially in cases of severe drug disease (when allopathic drugs are suppressing symptoms for many years), of lacking response to well-selected medicines, of oversensitivity to homeopathic medicines (when each dose even in low or moderate potency gives excessive reaction).
Study concerning practical application of latent psora requires significant amount of further practical work in specification and clarification. But many perspectives are seen even now: